The impact of probiotics and vitamin C on the prevention of upper respiratory tract symptoms in two preschool children cohorts

Abstract

Background/objectives: The efficacy of Lab4 probiotic and vitamin C combination on the prevention of upper respiratory tract infections (URTIs) was investigated in two studies with children. Our objective was to pool dataset of 57 preschool children from the PROCHILD study (ISRCTN28722693) and the dataset of 50 preschool matched cohort from the PROCHILD-2 study (ISRCTN26587549) to evaluate the impact of probiotic/vitamin C combination on the prevention of upper respiratory tract symptoms and provide a more robust assessment of effect using detailed individual level data.

Subjects/methods: The children were supplemented daily for 6 months with either the multistrain probiotic (1.25×10¹⁰ cfu/tablet consisting of two strains of Lactobacillus acidophilus CUL21 and CUL60, Bifidobacterium bifidum CUL20 and Bifidobacterium animalis subsp. lactis CUL34) plus 50 mg vitamin C or a placebo.

Results: In the pooled analysis of the individual participant data (per protocol population), significant reductions were observed for the incidence (-25%; 95% confidence interval [CI], 0.66, 0.85; P < 0.0001) and duration (-14.9 days; 95% CI, -24.8, -5.1; P = 0.0030) of typical URTI symptoms in the active group compared with the placebo. The incidence rates of absenteeism from preschool (IR ratio, 0.75; 95% CI, 0.66, 0.86; P < 0.0001), paediatric visits (IR ratio, 0.56; 95% CI, 0.47; 0.68; P < 0.0001) and antibiotic usage (IR ratio, 0.53; 95% CI, 0.39, 0.71; P < 0.0001) were also significantly reduced.

Conclusion: The pooled analysis findings of comparable preschool cohorts from two studies indicate that the supplementation with probiotic and vitamin C combination is beneficial in the prevention and management of URTI symptoms.

Keywords: Bifidobacterium; Lactobacillus; common colds; vitamin C.

Fig. 1. Flow diagram of the pooled analysis.

ITT, intention-to-treat; PP, per protocol. ¹⁾Garaiova et al., 2015 [17]; ²⁾Garaiova et al., 2021 [18].

Fig. 2. Incidence rate ratio forest plots (per protocol population): (A) cough, (B) sore throat, (C) nasal congestion, (D) nasal discharge, (E) sneezing, (F) Total upper respiratory tract infection symptoms (include at least one symptom of cough, sore throat, sneezing, nasal discharge or nasal congestion).

IRR, incidence rate ratio; CI, confidence interval; P2P, PROCHILD-2 preschool.